Pancreatic cancer usually has no symptoms in its early stages, so many people are diagnosed when the cancer is advanced. If the cancer involves nearby organs or blood vessels (locally advanced – some stage 3 cancers) or has spread to other parts of the body (metastasised – all stage 4 cancers), surgery to remove the cancer may not be possible.
Instead, treatments will focus on shrinking or slowing the growth of the cancer and relieving symptoms without trying to cure the disease (palliative treatment). Common symptoms of advanced pancreatic cancer include:
- digestive problems
- jaundice caused by narrowing of the common bile duct
- ongoing vomiting and weight loss caused by a blockage in the stomach or small bowel
- pain in the abdomen and middle back.
Some people think that palliative treatment is only for people at the end of life. However, it can help at any stage of a pancreatic cancer diagnosis. It does not mean giving up hope – rather, it is about managing symptoms as they occur, and living as fully and comfortably as possible. Some studies show that if the palliative team is seen early and symptoms are controlled, people will feel better and may live longer.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for pancreatic cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Surgery to relieve symptoms
If the tumour is pressing on the common bile duct, it can cause a blockage and prevent bile from passing into the bowel. Bile builds up in the blood, causing symptoms of jaundice, such as yellowing of the skin and whites of the eyes, itchy skin, reduced appetite, poor digestion and weight loss, dark urine, and pale stools.
If cancer blocks the duodenum (first part of the small bowel), food cannot pass into the bowel and builds up in your stomach, causing nausea and vomiting.
Surgical options for managing blockages
Blockages of the common bile duct or duodenum are known as obstructions. Surgical options for managing these may include:
- stenting – inserting a small tube into the bile duct or duodenum (this is the most common method)
- bypass surgery – connecting the small bowel to the bile duct or gall bladder to redirect the bile around the blockage, and connecting a part of the bowel to the stomach to bypass the duodenum so the stomach can empty properly
- gastroenterostomy – connecting the stomach to the jejunum (middle section of the small bowel)
- venting gastrostomy – connecting the stomach to an opening on the abdomen so waste can be collected in a small bag outside the body.
Sometimes the surgeon may have planned to remove a pancreatic tumour but discovers during the surgery that the cancer has spread. If the tumour cannot be removed, the surgeon may perform one of the operations listed above to relieve symptoms.
Inserting a stent
If the cancer cannot be removed and is pressing on the common bile duct or duodenum, you may need a stent. A stent is a small tube made of either plastic or metal. It holds the bile duct or duodenum open, letting the bile or food to flow into the bowel again.
A bile duct stent is also known as a biliary stent. It is usually inserted using an endoscope passed through the mouth, stomach and duodenum until it reaches the bile duct. You may have this procedure as an outpatient or stay in hospital for 1–2 days. Sometimes the stent needs to be inserted directly through the skin and liver into the bile duct. A duodenum stent is also known as a duodenal stent. It is usually inserted through the mouth using an endoscope.
Symptoms caused by the blockage usually go away over 2–3 weeks. Your appetite is likely to improve and you may gain some weight.
Targeted therapy and immunotherapy
Targeted therapy targets specific features of cancer cells to stop the cancer growing and spreading, while immunotherapy uses the body’s own immune system to fight cancer.
The targeted therapy drug called olaparib has been shown to provide some benefit for people with metastatic pancreatic cancer who have the BRCA gene changes. This is only a small number of people with pancreatic cancer. Olaparib is approved for use in Australia but the cost is not yet covered by the government through the Pharmaceutical Benefits Scheme (PBS) for pancreatic cancer.
Your doctors will be able to provide the latest information. So far, other targeted therapy and immunotherapy drugs have had disappointing results for pancreatic cancer, but research is continuing and there are new clinical trials underway. Talk to your treatment team about whether a clinical trial is an option for you.
More about clinical trials
Chemotherapy uses drugs to kill or slow the growth of cancer cells. It is used for pancreatic cancer for various reasons:
- If the cancer is at a stage where it can be removed with surgery, chemotherapy is often used before or after the surgery.
- When surgery cannot remove the cancer, chemotherapy can be used as a palliative treatment to slow the growth of the cancer and relieve symptoms.
- For some stage 3 cancers, chemotherapy may be combined with radiation therapy. This is known as chemoradiation.
Your medical oncologist will assess how the treatment is working based on your symptoms and wellbeing, as well as scans and blood tests. The blood tests will help show if your body is able to cope with the chemotherapy. Tell your team about any prescription, over-the-counter or natural medicines you are taking or planning to take, as these may affect how the chemotherapy works in your body.
Radiation therapy uses a controlled dose of radiation to kill cancer cells or injure them so they cannot multiply. The radiation is usually in the form of focused x-ray beams targeted at the cancer. Treatment is painless and carefully planned to do as little harm as possible to healthy body tissue near the cancer.
When radiation therapy is given
Chemoradiation – for stage 3 cancers that cannot be removed with surgery (locally advanced cancers), radiation therapy may be given with chemotherapy to slow the growth of the cancer. This is known as chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy. For cancers that are at a stage where they can be removed by surgery, chemoradiation may also be used before or after the surgery.
Radiation therapy on its own – radiation therapy may also be used on its own over shorter periods to relieve symptoms. For example, if a tumour is pressing on a nerve or another organ and causing pain or bleeding, a few doses of radiation therapy may shrink the tumour enough to relieve the symptoms.
SBRT – a newer radiation technique called stereotactic body radiation therapy (SBRT) delivers a higher dose of radiation per treatment session over a shorter period of time. SBRT is not standard practice for pancreatic cancer but is being investigated in clinical trials. SBRT may be a treatment option as part of a clinical trial at some cancer centres.
Side effects of radiation therapy
Radiation therapy can cause side effects, which are mainly related to the area treated. For pancreatic cancer, the treatment is targeted at the abdomen. Side effects of radiation therapy to the abdomen may include:
- nausea and vomiting
- poor appetite
- reflux (when stomach acid flows up into the oesophagus)
- skin irritation.
Most side effects start to improve a few weeks after treatment, but some can last longer or appear later. Late side effects are uncommon, but may include damage to the liver, kidneys, stomach or small intestine. Talk to your radiation oncologist or radiation oncology nurse about ways to manage these side effects.
Managing pain in pancreatic cancer
If pain becomes an issue, you may need a combination of treatments to achieve good pain control. Options for relieving pain may include:
- strong pain medicines such as opioids
- nerve blocks – injecting anaesthetic or alcohol into nerves
- anticonvulsant medicines to help control nerve pain
- chemotherapy and/or radiation therapy to shrink cancer pressing on nerves
- complementary therapies such as acupuncture, massage and relaxation techniques.
Tell your treatment team if you have any pain, as it is easier to control if treated early. Don’t wait until the pain is severe. Your team can also refer you to a pain specialist if needed.
More about cancer pain
Palliative treatment is one aspect of palliative care, in which a team of health professionals work together to meet your physical, emotional, cultural, social and spiritual needs.
Specialist palliative care services see people with more complex needs and can also advise other health professionals. Contacting a specialist palliative care service soon after diagnosis gives them the opportunity to get to know you, your family and your circumstances. You can ask your treating doctor for a referral.
The palliative care team may include a social worker, counsellor or spiritual care practitioner (pastoral carer), and they also provide support to families and carers.
Living with pancreatic cancer
Life after a diagnosis of pancreatic cancer can present many challenges. For some people, the cancer goes away with treatment. Other people will have ongoing treatment to manage symptoms. Many people diagnosed with pancreatic cancer think about what will happen to them if or when the disease progresses.
Being told that you have advanced cancer may bring up different emotions and reactions. Give yourself time to take in what is happening and accept that some days will be easier than others.
You might find it helpful to talk to your GP and the palliative care doctors and nurses about what you are going through. They can explain what to expect and how any symptoms will be managed.
You can also ask your specialist or GP about seeing a clinical psychologist or call our cancer nurses on 13 11 20 for emotional support. Try listening to The Thing About Advanced Cancer podcast.
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Understanding Pancreatic Cancer
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Expert content reviewers:
Dr Benjamin Loveday, Hepato-Pancreato-Biliary (HPB) Surgeon, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Dr Katherine Allsopp, Palliative Medicine Physician, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW; Hollie Bevans, Senior Dietitian, Radiotherapy and Oncology, Western Health, VIC; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Amanda Maxwell, Consumer; Prof Michael Michael, Medical Oncologist, Lower and Upper GI Oncology Service, Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre and University of Melbourne, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Gold Coast University Hospital, QLD; Meg Rogers, Nurse Consultant Upper GI/NET Service, Peter MacCallum Cancer Centre, VIC; Ady Sipthorpe, 13 11 20 Consultant, Cancer Council WA.
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The information on this webpage was adapted from Understanding Pancreatic Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in May 2022.